One-year outcomes after a strategy using enoxaparin vs. unfractionated heparin in
patients undergoing fibrinolysis for ST-segment elevation myocardial infarction:
1-year results of the ExTRACT-TIMI 25 trial.
Author(s): Morrow DA, Antman EM, Fox KA, White HD, Giugliano R, Murphy SA, McCabe CH,
Braunwald E; ExTRACT-TIMI 25 Investigators.
Affiliation(s): TIMI Study Group/Cardiovascular Division, Brigham and Women's Hospital, 75
Francis Street, Boston, MA 02115, USA. dmorrow@partners.org
Publication date & source: 2010, Eur Heart J. , 31(17):2097-102
AIMS: To determine the impact of a strategy using enoxaparin for up to 8 days
compared with unfractionated heparin (UFH) for 48 h as an adjunct to fibrinolysis
for ST-segment elevation myocardial infarction (STEMI) on 1-year clinical
outcomes.
METHODS AND RESULTS: Follow-up at 1 year (n = 20 275) was conducted by telephone
in the ExTRACT-TIMI 25 trial to ascertain the endpoints of death, MI, and
disabling stroke. The primary endpoint of death or non-fatal MI occurred in 1614
(15.8%) and 1732 (17.0%) of patients allocated to enoxaparin and UFH,
respectively [hazard ratio (HR) 0.92, 95% confidence interval (CI) 0.86-0.98, P =
0.01]. The enoxaparin strategy significantly reduced non-fatal MI at 1 year (5.7
vs. 6.8%, HR 0.82, 95% CI 0.73-0.92, P < 0.001). The risks of death (10.5 vs.
10.6%, HR 0.98, 95% CI 0.91-1.07) and disabling stroke (1.1 vs. 1.2%, HR 0.97,
95% CI 0.75-1.26) were not reduced. The composite of death, MI, or disabling
stroke favoured enoxaparin (HR 0.91, 95% CI 0.85-0.98, P = 0.007).
CONCLUSION: Compared with UFH for 48 h, a strategy using enoxaparin as an adjunct
to fibrinolysis resulted in a sustained reduction in death or MI at 1 year with
no additional benefit after 30 days. Mortality was not reduced at 1 year with the
enoxaparin strategy. The study was registered at ClinicalTrials.gov, NCT00077792.
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